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Spreading best practice


Gathering evidence for your first alliance meeting

It is important not to underestimate the initial planning work. Even with the advantage of being able to replicate the NOA’s methodologies, a very engaged and driven clinical lead and project manager were critical to the success of the UKOA. Timescale and delivery will be dependent on who is driving the project and how much time can be dedicated to this work.   The development of the UKOA is proof that with the right drive and commitment, quick replication is possible.

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Developing an implementation plan, based on the principles used by the NOA, is encouraged.  Replicating the NOA methodology was very effective for the UKOA.

Gathering evidence imagePre-planning communications

A draft communications and stakeholder plan is needed from the start.

Identifying very senior individuals who are willing to promote the alliance and be visible during the establishment phase will help external communications.

It will be helpful if the project lead has informal conversations with people identified as potential founder members. The formal invitation letter, setting out the purpose and aims of the alliance can then be sent.

Consider who will sign the first invitation letter.  It is advisable to ask a chief executive or medical director from a major unit to co-sign. 

The initial invitation should be sent to clinical leads, medical directors (MDs), CEOs, presidents, as appropriate to the organisation. Ensure they understand who is best to attend and that it should be a multi-disciplinary team including a clinical lead or senior consultant, manager and nurse.

Draft terms of reference

To enable discussion with potential members and stakeholders as well as provide context for the first meeting, it is helpful to set out the proposed aims and benefits of the alliance. The UKOA agreed it would:

Be a forum for regular liaison and discussion on efficiency, quality and other mutual areas of interest between key stakeholders for ophthalmic services.

Bring together the expertise of clinical professionals, managers and trust leaders in commissioning, operational management and financial flows. This joint expertise would establish quality standards and best practice or efficiency pathways in consultation with the key professional bodies, providers and patient bodies covering care provided by any ophthalmic professional in any setting.

Provide or support a web portal populated by NHS digital data and provider-supplied data, informed by GIRFT results, allowing benchmarking of processes and outcomes to drive up standards.

Enable buddying and support to improve quality and efficiency between providers with good and less good performance in specific areas.

Create a powerful voice which could negotiate locally and nationally for the benefit of ophthalmology commissioning and resourcing and champion the specialty generally.

Developing a methodology for agreeing clinical standards

Following the NOA process, the UKOA leads decided to invest in developing a first set of standards to demonstrate the methodology and show potential for success.  If this process is followed by future alliances, it is recommended that the project lead(s) identify potential areas of focus before the inaugural meeting.  It is useful to work up a potential quality standard or a guideline and generate a list of other potential quality standards for the members to comment on. It may be useful to consider standards:Gathering evidence image

  • that do not exist but should.
  • that people are already asking for.
  • for key safety issues which should be in place.
  • which would benefit from co-design with all stakeholders.
  • for patients including co-developed patient education and support materials.

To help think this through, it may be useful to consider how the UKOA approached this stage of the process.

Before the first alliance meeting the UKOA project team assessed various options for evidence searches and literature reviews and found that the British Medical Journal Evidence team, who had conducted the work for the NOA, were best placed to support this work.  Working with them, the team built on their NOA work to develop a template against which to analyse literature for our ophthalmic standards and a list of what those potential ophthalmic standards might be.

The two pilot topics chosen for quality standards were:

  • treatment of amblyopia (‘lazy eye’) in childhood (this was because it relates to all clinical professionals, not just ophthalmologists).
  • selection and insertion of intraocular lenses (IOLs) for cataract surgery (this was because it is the single biggest cause of surgical ‘never’ events).

Professional links and contacts were invaluable. A procurement efficiency lead from GIRFT was recruited, key national ophthalmology procurement leads were identified and NOA members suggested priorities for ophthalmology procurement which the NOA could support. In addition, information was shared about how the procurement landscape would change and how the alliance could influence that. This formed the basis of those involved in the subsequent procurement working group.

Key learning – preparing for your first alliance meeting

  • Agree the communications plan at the outset.
  • Canvass potential founder members informally.
  • Don’t underestimate the planning needed before any first alliance meeting.
  • Agree the implementation plan.
  • Be clear about proposed alliance aims and benefits to share with members.
  • Do some groundwork to bring topics for discussion to the first meeting.
  • It’s good to replicate other models but tailor each sub-specialty alliance as appropriate.
  • Remember this is collaboration so things may change once the members meet.